diagnosis – American Institute of Acupuncture

Diabetes Mellitus

acuherb — Fri, 06 Jan 2012 17:53:52 +0000

Diabetes MellitusÂ

Huang Di Hei Jing (The Yellow Emperor’s classic of Internal Medicine)Â is the earliest TCM theoretic book. It is divided into two partsSuwenÂ (The Book of plain Questions) andLingshuÂ (The Book of Miraculous Pivot)

In ancient China, the word “diabetes” did not exist. However, an early definition of the illness can be found in the medical classicHuang Di Nei Jing (The Yellow Emperor’s Classic of Internal Medicine)Â written during the Han Dynasty (approx. 200 BC). Under this book’sÂ Suwen (The Book of Plain Questions)section, diabetes was defined by the following symptoms “xiao ke” and “fei xiao,” which translate into excessive drinking, and “ge xiao” and “xiao zhong,” which mean excessive eating. According to theÂ Suwen, additional clues to the disease include excreting large amounts of urine with sugar in it and weight loss. The ancient Chinese people also thought it was caused by improper diet and mainly affected the upper class. TheÂ Book of Plain QuestionsÂ describes the diabetes sufferer as follows: ” When, a person has eaten too much greasy and sweet food, the body produces dry-heat evils which causesÂ qiÂ to stay in theÂ middle-burnerÂ of the body until finally the qi flows upward and spills over resulting in diabetes.” The “Efficacious Formulae Recorded from Antiquity to the Present,” penned by medical practitioner Zhen, Li-yan during the Sui Dynasty (589~618 AD), wrote that diabetes patients usually suffer from the following symptoms: “Frequent thirst that leads to excessive drinking, excessive urination, and urine that is sweet and without fat.”

Diabetes is generally attributed to a deficiency of body fluids and the excessive accumulation of dry or heat evils inside the body. Dry and heat evils come from external environmental sources such as an improper diet and are transformed internally into disease causing factors such as a kidney yin deficiency. Dry and heat evils trigger certain organs in the body to react negatively. The organs that are most affected are the lung, stomach and kidney.

	TheÂ Lungs:Â The lungs are responsible for the transformation and movement of water in the body. Dry-heat hurts the lungs and causes body fluid to flow straight down freely without being distributed to the rest of the body. This results in frequency in urination, thirst and excessive drinking, which are all symptoms of diabetes.
	TheÂ Stomach:Â The stomach is a reservoir for food and drink. An intense stomach fire is caused by dry-heat which damages the stomach. As a result, the metabolic rate rises and triggers an increase in appetite and constipation. An increase in appetite is also another hallmark symptom of diabetes.
	TheÂ Kidneys:Â Since the kidneys control water metabolism, deficiency of the kidney-yin and “virtual fire”(the heat developed inside the body by a relative excess of yang) creates dry and heat evils. This damages the “vaporization” function and results in the kidneys’ failure to separate turbid water, which will be turned into urine and clean water, which is reused by the body. It also affects the opening and closing of the bladder. The end result is an excessive amount of urine, urinary frequency and the production of urine with traces of sugar.

Understanding water metabolism from a TCM perspective

In western medicine diabetes mellitus is a metabolic disorder that occurs when there is a chronically high level of glucose (sugar) in the blood caused by a deficiency or complete lack of insulin. The insulin deficiency and high glucose levels cause serious damage to the body over time if left untreated and in severe cases may cause death.

This western understanding of diabetes is not present in TCM. Its diagnosis is based on the clinical symptoms of diabetes such as excessive thirst, hunger and urination, which may or may not be accompanied by sudden weight loss. Depending on each individual’s symptoms, it is further classified into four types of disharmony patterns discussed in the diagnosis section. Even though two people may be diagnosed with diabetes from a western perspective, these individuals may present with two different disharmony types from a TCM perspective and thus will be treated differently.Â

Causes

The primary causes of diabetes are detailed below.Â

1.	Congenital Deficiency
Â	Individuals born with a congenital deficiency are genetically susceptible to this disease. Dysfunction of the lungs and kidneys affects the water metabolism in the same way dysfunction of the spleen and stomach affects digestive power. In turn, these organs cannot function properly and diabetes is caused by the mechanisms listed in theÂ definitionÂ section.
2.	Improper Diet
Â	Over consumption of greasy food and alcohol drinks may impair the stomach and the spleen, which in turn fail to transform and transport these substances into nutrition for the body. The undigested food then accumulates and transforms into heat and dryness evils, and consumes the body fluid, which causes thirst and excessive drinking.
3.	Emotional Disorders
Â	Over stimulation of emotions may spark stagnation ofÂ vital qiÂ and then transform it into a heat-evil, which consumes theÂ yin-fluid of organs like the lungs and stomach. Symptoms of diabetes occur when the body’s metabolism becomes unbalanced from dysfunction of the lungs and spleen.
4.	Tension
Â	Overwork leads to consumption of yin-essence in the kidneys and produces internal fire or heat evils. This accelerates the depletion the nutrients and triggers a rise in metabolic rates, which results in increased appetite but with weight loss. An increased appetite and weight loss are some of the classic symptoms of diabetes.
5.	Pleasure Indulgences
Â	Excessive sexual activity can cause consumption of kidney essence (a yin-component that includes sperm and egg cells and blood), which leads to a relative excess of yang. When this occurs, a “virtual fire” or a heat evil is created which heats up the lungs and stomach causing organ damage. In turn, these organs cannot function properly and diabetes is caused by the mechanisms listed in the definition section.
6.	Drugs
Â	Improperly used libido drugs can cause heat evils to accumulate in the lower-burner. When individuals consume them for a long time and get older, the kidney yin will become insufficient and cause damage to the kidneys’ “vaporization” function. SeeÂ definitionÂ section. The damage of this function is one of the causes of diabetes.

Symptoms

TCM practitioners recognize symptoms of diabetes from both a western and eastern point of view.

Clinical distinction in western medicine:Â Type I diabetes occurs in individuals who do not produce any insulin. The onset of Type I diabetes begins at a young age. Clinical symptoms change quickly and become increasingly more serious. Typical signs include excessive and constant thirst, excessive drinking and eating, excreting an excessive amount of urine with sugar in it, and weight loss.Â

Type II diabetes occurs in individuals who do not have enough insulin or whose insulin does not work properly. The onset of Type II diabetes usually begins in middle or old age. However, the disease may be present in a sub clinical form for years before diagnosis. The main symptoms are extreme fatigue, dry mouth and excessive thirst. Other symptoms like excessive urination, and excessive eating may not be as obvious with this type.Â

According to Traditional Chinese Medicine diagnosis, the disease can be divided into four types of disharmony patterns:Â

1.	Yin DeficiencyÂ and Excessive Heat Type Symptoms related to this type include thirst for cold drinks, an increased appetite, and dislike of heat and emotional imbalances. Other symptoms include dark urine, constipation, an appearance of a red tongue with a yellow coating and a pulse that feels rapid and taut or slippery.
2.	Deficiency ofÂ QiÂ and Yin Type Symptoms include shortness of breath, heart palpitations, fatigue and weakness that can lead to reluctance to speak. Additional symptoms include: constant thirst, spontaneous sweating, sweating during sleep, being easily irritable, having trouble sleeping, feeling heat in the palms of the hands and soles of the feet, dark urine and constipation. The tongue appears dry, red and swollen, while the coating is scaled off. The pulse is weak and uneven.
3.	BloodÂ Stasis and Internal Obstructed TypeÂ Symptoms include darkened skin, weight loss and malaise, fullness and blurred pain in the chest, numbness or stabbing pain in limbs, which worsens at night. People who suffer from this form of diabetes will also have purple-colored lips, and a tongue that is dark in color or appears bruised. The tongue will also be covered with a thin white or yellow colored coating, or appear dark and bruised. The pulse feels taut or uneven.
4.	Deficiency of Yin andÂ YangTypeÂ Symptoms include a below normal body temperature, aversion to coldness with cold feeling limbs, a pale face, ringing in the ears, weakness in the lower back, occasional fever, sweating at night, impotence or premature ejaculation of sperm. The stool is loose and excessive clear urine is passed. The bulging tongue appears light pink, and is blanketed with a thin white coating or a white greasy fur. The pulse is faint or rapid and uneven.

Other related patterns:Â
Accumulated Internal Wet Heat Type:Â The body appears fat and bloated. The mouth is dry and has a bitter taste with foul smelling burps. Other symptoms include itchy skin, yellow and cloudy urine, and loose stool. The tongue appears swollen and is covered with a yellow greasy or turbid yellow greasy fur coating. The pulse feels weak and slippery.Â

Diagnosis

TCM practitioners will diagnosis diabetes according to its clinical symptoms and further characterize it by the disharmony pattern an individual displays.

Diabetes, as is commonly understood from a western medicine perspective, is largely dependent on western methodologies for diagnosis. (See western medicine diagnosis section.)

TCM Examination Techniques:
Diagnosis in TCM is based on four examination techniques. The first is “questioning.” The TCM practitioner will want to know what the individual’s current complaints are, and their family’s medical history. The second technique is “observation.” Physical features of the body such as the face, tongue, hair, nails, sputum (mucus that is coughed up) and examining the area of pain all offer clues to the problem. The tongue is particularly useful gage to assess illness because it is seen as a window to look at the functioning of internal organs. The third technique is “hearing and smelling.” Smelling the sputum and breath and listening to the sounds coming from the chest offer additional clues. The last technique used in examination is “touching.” Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about the body’s imbalance.Â

In TCM theory, diabetes is characterized by a combination of symptoms below:

	Excessive eating
	Excessive drinking
	Excessive urine
	Wasting of body tissues or weight loss

Note:Â If a TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she will recommend the individual see a western doctor for further follow up. When an individual experiences severe symptoms like those listed above, it should be taken very seriously, and the appropriate medical care should be sought out preferably in an emergency setting.Â

The four Types of Disharmony PatternsÂ Even though diabetes can be diagnosed from the above symptoms, the information gathered from the TCM physical examination is used to determine which type of disharmony pattern an individual has. This is important because at the various stages of a disease, a varicty of disharmony patterns are present which require different types of therapy. This is the reason two individuals with the same disease may be treated very differently by their TCM practitioner.Â

1.	Yin Deficiency and Heat Excessive Type
Â	In TCM,Â yin deficiencyÂ commonly refers to a deficiency of yin fluids such as blood and body fluids. Without sufficient nourishment by these fluids, excitatory functions (heat excessive manifestations) become dominant and lead to symptoms of fever, thirst or increased appetite.
2.	Deficiency of Qi and Yin Type
Â	QiÂ can be interpreted as the “life energy” or “life force,” that flows within us. Deficiencies in qi and yin result in organ dysfunction. In diabetes, the most affected organs are the lungs, stomach and kidneys.
3.	Blood Stasis and Internal Obstructed Type
Â	This refers to a state where theÂ bloodÂ cannot circulate smoothly, and is usually accompanied by qi stagnation. The organs lose nutrients from the blood, which cause symptoms like numbness in the limbs or localized tissue death. For example, people with diabetes may suffer from ulcerations in their legs and feet due to poor blood supply.
4.	Deficiency of Yin and Yang Type
Â	The body’s physiological functionsÂ (yang)Â and physical formsÂ (yin)Â are maintained in constant balance to achieve health. WhenÂ vital qiÂ is severely deficient for a long time, this type will develop. It is a more general type of deficiency that can occur in many diseases such as diabetes.

Other Related Disharmony Patterns:Â Accumulated Internal Wet Heat TypeÂ Improper diet is one of the causes of diabetes from a TCM perspective. This impairs the proper functioning of theÂ spleenÂ andÂ stomach, which leads to formation of wet and heat evils. These evils affect the fluid metabolism inside the body, and diabetes symptoms like excessive thirst and hunger can appear.Â

Diabetes should be differentiated from hyperthyroidismÂ (over-functioning of the thyroid gland)

Sometimes it is difficult to distinguish diabetes from hyperthyroidism since both share similar symptoms. In both conditions there may be the presence of an increased appetite associated with weight loss. Diabetes patients are frequently thirsty, and excrete an excessive amount urine with glucose (sugar) present in it. However, people suffering from hyperthyroidism experience irritability, excrete loose yellow stools, and have eyelid retraction and eyeball protrusion. Individuals with this condition may also suffer from a rapid and forceful heartbeat, and swelling of the thyroid gland in the neck. To safely make the distinction, laboratory examinations of the blood and urine can be done to diagnose these two conditions.

Treatment

Even in ancient times, TCM practitioners knew diabetes was a serious life threatening disease if not treated properly. Below lists some of the prescription examples used to treat the different disharmony patterns that occur in diabetes.Â

Yin Deficiency and Heat Excessive Type

Therapeutic aim:Clears away heat and dry evils, nourishes yin to promote the production of body fluid

Prescription:Â
Individuals with minor cases:
Xiaoke Fang

Huang lian	golden thread
Gau lou gen	snakegourd root
Sheng di huang zhi	juice of fresh rehmannia root
Hua fen	pollen
Ou zhi	Juice of fresh lotus root
Ren ru	human milk

Individuals with severe cases:Â
Wu zhi yu quan pillÂ

Huang lian	golden thread
Zhi mu	common anemarrhena root
Wu mei	dark plum
Gan cai	liquorice root
Ren shen	ginseng
Mai dong	dwarf lilyturf tuber
Wu wi zi	Chinese magnolia vine fruit
Di huang	rehmannia root
Dang gui	Chinese angelica
Hua fen	pollen
Ge gen	kudzu vine root
Lian rou	lotus rhizome node
Ren ru	human milk
Niu ru	milk
Zhe zhi	juice of Sugar cane
Li zhi	pear juice
Ou zhi	juice of fresh lotus root

Deficiency of Qi and Yin Type

Therapeutic aim:Invigorates qi and nourishes yinÂ

Prescription:Â
Individuals with minor cases:
Huang qi decoctionÂ

Huang qi	milkvetch root
Fu ling	Indian bread
Mai dong	dwarf lilyturf tuber
Di huang	rehmannia root
Tian hua fen	snakegourd root
Wu wi zi	Chinese magnolia vine fruit
Gan cao	liquorice root

Individuals with severe cases:
Di huang drinkÂ

Ren shen	ginseng
Huang qi	milkvetch root
Tian mai dong	cochin Chinese asparagus root
Shi hu	dendrobium
Pi pa ye	loquate leaf
Ze xie	oriental water plantain root
Zhi qiao	orange fruit
Sheng shu di	rehmannia root (processed & unprocessed)

Blood Stasis and Internal Obstructed Type

Therapeutic aim:Invigorates qi, enriches the blood and removes obstruction in the meridian channelsÂ

Prescription:Â
Bu yang hai wu decoctionÂ

Huang qi	milkvetch root
Gui wei	tail part of Chinese angelica root
Chis hao	red peony root
Tao ren	peach kernel
Hong hua	safflower
Di long	earthworm
Chuan xiong	Szechwan lovage root

Deficiency of Yin and Yang Type

Therapeutic aim:Nourishes yin and warms yang

Prescription:
Lu rong pillÂ

Huang qi	milkvetch root
Ren shen	ginseng
Mai dong	dwarf lilyturf tuber
Wu wi zi	Chinese magnolia vine fruit
Xuan shen	figwort root
Shu di	processed rehmannia root
Yu ru	dogwood fruit
Lu rong	hairy antlers of young stag
Po gu zhi	malaytea scurfpea fruit
Ru cong rong	desert living cistanche
Di gu pi	Chinese wolfberry root-bark
Fu ling	Indian bread
Huai hiu xi	achyranthes root

Western Medicine Treatment

1. Pharmacological Therapy:

Type 1 Diabetes
Insulin is the mainstay therapy for patients with type 1 disease. Most patients are on human insulins, which are synthesized by recombinant DNA technology. Beef (no longer available in the U.S.) and pork insulins are less preferred due to potential of antigenic (allergic) reactions such as itching and skin reactions at the injection sites. Of the available insulins, some are rapid acting, or short acting, which are used mainly before each meal. Others are intermediate acting, or long acting, which are injected once or twice daily under the skin. Table 1 is a summary of the onsets of action, duration of action and other characteristics of the various insulins available (in the United States).Â

Type /Name	Onset (hour)	Peak (hour)	Duration (hour)	Appearance
Lispro	10 – 15 mins.	30 – 90 mins.	<=5	Clear
Aspart	15 mins.	45 – 90 mins.>	3 – 5	Clear
Regular	1/2 – 1	2 – 4	5 – 7	Clear
NPH/Lente	1 – 3	6 – 14	24 +	Cloudy
Ultralente	4 – 10	8 – 20	18 – 28	Cloudy
Glargine	5	no peak	24 +	Clear
NPH70/Reg 30	1/2	2 – 12	+/- 24	Cloudy
NPH50/Reg 50	na	na	+/- 24	Cloudy

Type 2 Diabetes
Of the proposed pathology of type 2 diabetes (see figure 1), there are now different oral pharmacological agents to target the specific defects: there are three categories of agents, the insulin secretagogues, inhibitors of glucose breakdown, and the insulin sensitizers. The insulin secretagogues include sulfonylureas and metiglinides, which are used to stimulate more insulin secretion. Alpha-glucosidase inhibitors delay the absorption of glucose and are usually used to control post-meal hyperglycemia. The insulin sensitizers include biguanides and thiazolidinediones, which can help the available insulin to be taken up more effectively. Table 2 lists the different agents with their sites and mechanisms of actions.

Click here to see the Table 2 Pharmacologic Classes to Control Hyperglycemia in Type 2 Diabetes

The selection of agents for a patient with type 2 disease will depend on the degree of hyperglycemia, particular defects, as well as other contraindications that may be present. Table 3 lists the agents according to their relative potency, other non-glycemic effects and adverse effects.Â

Click here to see the Table 3 Relative Efficacy and Adverse Effects of the Oral Agents Used in Type 2 Diabetes

If we look at the patient according to the natural progression of diabetes, oral agents can also be picked according to the severity of disease. (See table 2) For example, an alpha glucosidase inhibitor or metiglinide may be most appropriate for someone who has mildly elevated glucose level after eating a meal. As this patient becomes less controlled with higher glucose and elevated fasting levels, we may then consider sulfonylureas, biguanides, or thiazolidinediones, all of which are considered more potent agents. There will be patients who may have multiple defects in the pathogenesis of their disease, therefore, will require a combination of agents (with different mechanisms of action) in order to control their diabetes. This can include the combination of different oral agents as well as combination of oral agents and insulins. Metformin can be particularly useful among patients who have concurrent problems with weight, cholesterol and triglycerides because it can also improve these indices. Concerns with the use of these oral agents lie in the side effects they can cause. Therefore, frequent and regular monitoring of patients is necessary to avoid hypoglycemia while they are on sulfonylureas, and to avoid stomach gas and diarrhea while they are on metformin. Metformin is also associated with a rare problem of lactic acidosis when it’s accumulated in the body with deterioration of kidney function. Gastrointestinal gas and diarrhea are often causes of therapy discontinuation in patients taking acarbose and miglitol. The thiazolidinediones are also associated with rare liver toxicities and need frequent monitoring of the liver enzymes.

2. Therapeutic Approach:

It’s recommended that the first stage of therapy for diabetes should include diet and exercise. An average size adult patient with diabetes should receive approximately 2000 calories per day with 60% carbohydrate, 20% protein, and 20% fat. However, calories or fat should be more restricted if the patient is overweight or has abnormal cholesterol / triglycerides; carbohydrate limited if glucose is uncontrolled; and protein also restricted if the patient has kidney complications from diabetes. Exercise should be incorporated into the therapeutic program (with doctor’s approval and supervision) because it will enhance the body’s sensitivity to insulin and increase utilization of glucose. Diet and exercise should be encouraged in all patients with diabetes and should remain a component of the therapeutic program as long as patients are compliant and gain benefits. Unfortunately, there are many patients who are not willing to diet or physically unable to exercise, and therefore should receive medications to aggressively control glucose early on during their disease.

Type 1 Diabetes
In a patient with newly diagnosed type 1diabetes, clinicians often start with a simple schedule of insulins. To improve glucose control, doses of the insulin(s) and / or the schedule may have to be adjusted often and on an as-needed basis. A typical regimen to start with includes intermediate- or long-acting insulin once or twice daily with short- or rapid-acting insulin before meals. However, patients with type 1 disease often have big fluctuations of glucose levels and suffer from extreme hyperglycemia or hypoglycemia. Therefore, tighter control is often necessary. Until recently, changing the timing of insulin injections and the dosage of different insulins were all that could be done to maximize glycemic control in type 1 patients. Over the last two years, however, rapid acting insulins have been made available, which made the control of glucose more precise. (See table 1) Instead of injecting the short-acting regular insulin about 30 minutes before meals, patients can inject the new rapid-acting insulins (lispro, aspart) within 15 minutes before meals. In addition, the newly available basal insulin glargine will make the control of glucose more consistent due to its slow release profile, which acts similarly to the physiological pattern of insulin release in our body.Â

Before injecting insulin, tap the syringe to rid it of any air bubbles.

Prick the skin and underlying fatty tissue to avoid injecting into an artery or vein.

Type 2 DiabetesÂ
Due to the recent differentiation in the pathogenesis of type 2 diabetes, there have been changes in the way we manage the disease. As previously mentioned, type 1 patients have an absolute lack of insulin and require insulin injections; type 2 patients have a relative lack of insulin, either due to insensitivity to insulin or an insulin receptor defect, improper timing of insulin secretion, abnormal glucose production, or a combination of these factors. In patients with type 2 diabetes, herapeutic approaches should target the specific defect(s) in each patient. A proposed algorithm based on the level of glycemic control is described as following:Â

Nutritional therapy / Exercise program x 3 month trial

If inadequate response or therapeutic goal is not met….

Add oral monotherapy x 4-12 weeks, titrate to maximum tolerable dose

If inadequate response or therapeutic goal is not met….

Add second oral agent x 4-12 weeks, titrate to maximum tolerable dose

If inadequate response or therapeutic goal is not met….

Add Oral agent(s) + insulinÂ
OR Insulin therapy aloneÂ
OR Oral agent(s) day + insulin at bedtime

Prevention

	Eat a balanced diet.Â The Book of Plain QuestionsÂ orSuwenÂ (approx. 200 BC) says: “Cereal is the foundation of the basic diet, meat provides protein and fat which is very useful, fruits can promote the digestion of food, and vegetables provide suitable supplements.” This ancient diet recommendation matches the modern day dietary management of diabetes, which is to eat a balanced diet with low sugar and fat intake.
Â	Â
	Exercise regularly.Â A nutritious diet and adequate exercise play important roles in diabetes. Daily exercise should be encouraged in order to promote the utilization of glucose (sugar) by the body tissues and decrease the body’s insulin requirement.
Â	Â
	Live a balanced life.Â Long hours at work and a stressful and fast-paced environment can make people more susceptible to illness. As a result living a balanced life mixed with both work and pleasure can help the brain and body to stay healthy and may help to lessen the severity of the diabetes or prevent diabetes onset.
Â	Â
	Be aware of family medical history and conditions that increase the risk of getting diabetes. Individuals with a history of diabetes, high blood pressure and obesity in their family should be aware that these conditions could predispose them to getting diabetes. Additionally, individuals who already have risk factors such as high blood pressure and who are obese should regularly have their blood sugar level checked by their doctor to make sure they have not developed the disease.

Colorectal Cancer

acuherb — Thu, 29 Dec 2011 18:20:28 +0000

Colorectal Cancer

Colorectal cancer is a Western medical term and is not specifically discussed in classical TCM texts. However, the main symptoms and signs of the disease are recorded in the following conditions:

	Intestinal mass ‘chang ji’: refers to movable abdominal mass accompanied by pain or distention.
	Bloody stools ‘chang pi’: refers to projectile bleeding from the rectum during defecation. This is due to the attack ofÂ wind evilsÂ in theÂ stomach, leading to prolonged accumulation ofÂ dampness evilsÂ in theÂ large intestine. It affects the distributing areas ofÂ Shao Yin meridiansÂ finally.
	Abdominal mass ‘zheng ji’: the mass seen over the abdomen. When it is always palpable and immovable, accompanied by localized pain is named as “zheng”, and that with intermittent occurrence, movable and accompanied by wandering pain is named as “ji”.
	Organ intoxication ‘zang du’: refers to a dark reddish bloody discharge due to prolonged organ damage. This causes inflammation of the lining of the large intestine due to accumulation of toxic material in theÂ organs.
	Hematochezia ‘bian xue’: passage of bloody stools; due toÂ heat evilsÂ damaging the vessels and lettingÂ bloodÂ escape into the surrounding tissues. It also present when there is accumulation of virulent dampness evil in the large intestine, deficiency ofÂ spleenÂ yang and stomach yang, or accumulation of wind evil at the yinfen level (the deeper level of the body).
	Diarrhea ‘xia li’: Excessive and frequent evacuation of watery feces, usually indicating gastrointestinal distress or related disorder.
	Rectal carcinoma blocking the anus ‘suo gang zhi’: a carcinoma causing narrowing of the rectum and anus, resulting in the discharge of slender feces and foul fluid, and accompanied by tenesmus (painful, ineffectual straining to empty the bowel).

All these TCM conditions present similar symptoms to colorectal cancer. The TCM physicians usually consider all of the above conditions during consultation.

Causes

According to TCM, formation of cancer is generally due to the depletion ofÂ disease preventing factorsÂ andÂ yin-yangÂ disharmony of the body, which can result in different types of pathological phenomena, such as qi stagnation, blood stasis,Â phlegmÂ condensation, toxicÂ heatÂ accumulation, andÂ dampnessÂ collection. These morbid conditions interact with each other and cancer may form when they further interact withÂ external pathogenic factors.

The usual causative factors are as follows:

Improper Diet
TCM takes food very seriously and regards theÂ middle burnerÂ Â (body region where theÂ spleenÂ andÂ stomachÂ are located) as the area for digestion. The digestive organs are vulnerable to inappropriate and unbalanced dietary habits, for example, excessive eating, greasy diet, over consumption of alcohol, and unclean foods. When theÂ transportation and transformationÂ processes are affected, undigested foods remain too long in the region and brew into dampness and heat evils. These evils accumulate and infuse downward into theÂ large intestine, causing qi stagnation, and blood stasis in the intestines. The dampness, heat, stasis, and toxic materials all blend together and may cause cancer over time.

Emotional Problems
Extreme emotional conditionsÂ like pensiveness and anxiety leads to under-functioning of the liver and affects the movement ofÂ qiÂ (vital energy) mainly, causing the formation of internal pathogenic factors such as dampness and phlegm. When these evils further stagnate, they transform into toxic heat evils, which then infuse downward and invade the intestines. This gives rise to qi stagnation and blood stasis in the intestines. Cancer may occur after a long period if the condition persists.

Uncontrolled Chronic Dysentery or Diarrhea
Persistent diarrhea leads to depletion of qi (vital energy) in the body which affects the spleen. In TCM, when the spleen cannot perform its transportation and transformation functions to send the pureÂ nutrient essenceÂ upward to the heart and lungs where it is transformed into qi and blood for body nourishment, qi (vital energy) movement becomes abnormal and results in a morbid state. Impure substances orÂ retention of phlegm and static fluidÂ then build up. When this condition lasts for long periods, the internal equilibrium is disturbed, and cancer can easily form.

Symptoms

In TCM, colorectal cancer has a similar clinical presentation to Western medicine; however physicians also focus on changing symptoms, the individual’s constitution, and the order in which symptoms appear. TCM practitioners first carry out a comprehensive consultation to gather an accurate picture of the internal disharmonies before implementing treatment. See article on“What to Expect from a TCM Doctor’s Examination”. The usual disharmony patterns caused by colorectal cancer are as follows:

1.Â Downward migration ofÂ damp-heat
Individuals present with abdominal cramps, diarrhea with mucous and bloody stools and tenesmus (painful, ineffectual straining to empty the bowel). There is a burning sensation in the anus and a palpable abdominal mass. Other associated symptoms include fever, aversion to cold, thirst, mouth dryness and general weakness.

3. Interior retention ofÂ bloodÂ stasis2. Excessive accumulation of poisonousÂ pathogens
The main presentations are poor appetite, feverish sensation accompanied with chest oppression, thirst, abdominal distention and cramping and severe diarrhea with mucous stools (which are dark purple in color).

Individuals present with an abdominal mass accompanied by fixed and persistent pain, abdominal distention, straining when defecating, diarrhea with pus and blood, a grayish complexion and a skinny appearance.

4. Deficiency in qi (vital energy) and blood
Individuals present with a pale complexion, light-colored lips and nails, general weakness, shortness of breath, bland taste in the mouth, poor appetite, full sensation in the epigastric region, tenesmus (painful, ineffectual straining to empty the bowel) orÂ anal prolapseÂ Â in severe cases, malnutrition and a skinny appearance.

5.Â Yang deficiency in spleen and kidneyÂ
Individuals present with a pale complexion, general malaise, apathy, aversion to cold temperatures, limb coldness and poor appetite. There can also be abdominal pain and distention, diarrhea in the morning and weakness and soreness in the lumbar (lower back) and knee regions.

6. Yin deficiency in liver and kidney
Individuals have a skinny appearance, dizziness, ringing in the ears, hot sensation in the chest, palms and soles, insomnia with nightmares, lumbar soreness, leg weakness and constipation with or without abdominal pain.

Diagnosis

Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and observation of symptoms. Diagnosis is based on the four traditional examination techniques:

Questioning: The TCM practitioner will establish the medical history of both the patient and his family.

Observation: Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.

Listening and Smelling: The odor of sputum and breath and listening to chest sounds offer additional clues to the patient’s health.

Touching: Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

TCM practitioners will usually begin with a full investigation of the patient and categorize symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present at different stages of a disorder. See article on “Principles of Diagnosis” In addition to manifestations of colorectal cancer as mentioned previously, practitioners also use pulse and tongue examination to obtain a diagnosis.

1. Downward migration ofÂ damp-heat
The major diagnostic presentations are abdominal cramps, diarrhea with mucous and bloody stools, tenesmus (painful, ineffectual straining to empty the bowel and bladder), and a burning sensation in the anus. On examination, the tongue is red, and covered by yellow and greasy fur. The pulse isÂ rollingÂ and rapid.

2. Excessive accumulation of poisonousÂ pathogens
The major diagnostic presentations are poor appetite, fever with dysphoria (an emotional state characterized by anxiety, depression, or unease), thirst, abdominal distention and cramping, diarrhea with mucous feces (which are copious and dark purple in color). On examination, the tongue is red, and covered by yellow or dried yellow colored fur. The pulse isÂ surgingÂ Â and rapid.

3. Interior retention of blood stasis
The major diagnostic presentations are fixed and persistent abdominal pain and grayish complexion. On examination, the tongue is dark and purple in color, and covered with brusied spots. The pulse is hesitant orÂ tautÂ orÂ knottedÂ and intermittent.

4. Deficiency inÂ qiÂ (vital energy) and blood
The major diagnostic presentations are pale complexion, light-colored lips and nails, general weakness and shortness of breath. On examination, the tongue is pale with a thin and white coating; the pulse is deep andÂ thready.

5. Yang deficiency inÂ spleenÂ andÂ kidney
The major diagnostic presentations are pale complexion, aversion to cold temperatures, limb coldness and diarrhea in the morning. On examination, the tongue is bulky and the pulse is deep, thready, and weak.

6. Yin deficiency inÂ liverÂ and kidneyÂ
The major diagnostic presentations are constipation, wasting of body tissue, dizziness, ringing in the ears, and a feverish sensation in the chest, palms, and soles.
On examination, the tongue is dark red and covered by scanty fur. The pulse is thready and taut, or rapid and thready.

Treatment

Various TCM therapies can be used at any stage of the disease or in combination with Western treatment at any time. Individuals can benefit from its preventative effects, improve their quality of life or boost the immune system, relieve or eliminate adverse effects caused by chemotherapy, and even help in the palliative care of terminal cancer patients. The following methods are for general information only; a qualified physician should always be consulted for treatment options. Self-treatment is not recommended.

Treatment based on TCM differential diagnosis

Physicians select theÂ treatment methodÂ according to TCM differential diagnosis, the “disharmony patterns” made by analyzing the collected data. All these remedies are adjusted to suit specific individual conditions.

Downward migration of damp-heat
Therapeutic aim:Â to clear away heat in order to drain dampness. Commonly used prescriptions areÂ huaihua diyu tang,qingchang yin, orÂ baitouwengÂ tang.

Sample prescription:Â baitouweng tangÂ (ç½é ç¿æ¹¯)

bai tou weng	Root of Chinese Pulsatilla
huang lian	Rhizome of Chinese Goldhread
huang bai	Bark of Chinese Corktree
qin pi	Chinese Ash Bark

Excessive accumulation of poisonous pathogens
Therapeutic aim:Â to clear away heat to cool blood, remove stasis, and detoxify the body. Commonly used prescriptions arewuwei xiaodu yiÂ andÂ huanglian jiedu tang.

Sample prescription:Â huanglian jiedu tang(é»ƒé€£è§£æ¯’æ¹¯)

huang lian	Rhizome of Chinese Goldhread
huang qin	Root of Baikal Skullcap
huang bai	Bark of Chinese Corktree
zhi zi	Fruit of Cape Jasmine

Interior retention of blood stasisÂ
Therapeutic aim:Â to clear away heat to cool blood, remove stasis, and detoxify the body. Commonly used prescriptions arewuwei xiaodu yiÂ andÂ huanglian jiedu tang.

Sample prescription:Â xiefu zhuyu tangÂ (è¡€åºœé€ç˜€æ¹¯)

dang gui	Chinese Angelica Root
sheng di	Dried Rehmannia Root
tao ren	Peach Seed
hong hua	Safflower Flower
zhi ke	Bitter Orange
chi zhao	Common Peony Root
niu xi	Twotooth Achyranthes Root
jie geng	Balloonflower Root
chuan xiong	Szechuan Lovage
chai hu	Chinese Tororwax Root
gan cao	Liquorice Root

Deficiency in vital energy (qi) and bloodÂ
Therapeutic aim:Â to replenish qi and nourish the blood. Commonly used prescriptions areÂ guipi tangÂ andÂ bazhen tang.

Sample prescription:Â guipi tangÂ (æ¸è„¾æ¹¯)

bai shu	Large Head Atractylodes Root
fu ling	Indian Bread
huang qi	Mongolian Milkvetch Root
long yan rou	Logan Aril
suan zao ren	Spine Date Seed
ren shen	Ginseng Root
mu xiang	Root of Common Aucklandia
zhi gan cao	Liquorice Root (processed with honey)
dang gui	Chinese Angelica
yuan zhi	Root of Thinleaf Milkwort
sheng jiang	Rhizome of Common Ginger
da zao	Common Jujube Fruit

Yang deficiency in spleen and kidney
Therapeutic aim:Â to warm and tonify the spleen and kidneys. Commonly used prescriptions areÂ zhenling baishu sanÂ andsishen wan.

Sample prescription:Â shenling baishu san(åƒè‹“ç½è¡“æ•£)

ren shen	Ginseng Root
fu ling	Indian Bread
bai shu	Large Head Atractylodes Root
bai bian dou	White Hyacinth Bean
huai shan	Chinese Yam
lian zi	Seed of Hindu Lotus
sha ren	Fruit of Villous Amomum
yi yi ren	Seed of Job’s Tears
jie geng	Balloonflower Root
gan cao	Liquorice Root

Yin deficiency in liver and kidney
Therapeutic aim:Â to nourish and tonify the liver and kidney. A commonly used prescription isÂ zhibai dihuang wan.

Sample prescription:Â zhibai dihuang wan(çŸ¥æŸåœ°é»ƒä¸¸)

shu di	Processed Rhemannia Root
shan yu rou	Asiatic Cornelian Cherry Fruit
huai shan	Chinese Yam
dan pi	Tree Peony Bark
fu ling	Indian Bread
ze xie	Oriental Water-plantain Root
zhi mu	Common Anemarrhena Rhizome
huang bai	Bark of Chinese Corktree

External Treatment

Treatments other than the oral drugs include acupuncture, plasters, sauna, and massage. These methods are commonly applied to localized lesions according to the presentation of symptoms.

Acupuncture
To relieve pain and vomiting, selected acu-points are:
zu-san-li, tian-shu, he-gu, xia-ju-xu, nei-guan, and da-chang-shu.

Topical application of drugsÂ Moxibustion
This is suitable for colorectal cancer patients who have complications such as ascites (free fluid accumulating in the abdominal cavity). Selected acu-points are:
tian-shu, zhong-wan, xia-wan, guan-yuan, shen-quel.Â
Recommended treatment is 2-3 times daily.

This refers to local application of pounded fresh medicinal herbs or moisturized medicinal powder over the affected part. They are applicable for local infections, ulcers, swelling, pain and injuries. In this case, individuals can apply to relieve pain caused by cancer, e.g. toad paste.

Enema
This refers to the introduction of a liquid into the bowel via the rectum, to be either expelled or retained. It is suitable for individuals with bloody stools. For example, a TCM decoction is prepared using the bark of Chinese Corktree (huang bai), root of Baikal Skullcap (huang qin), root of Redroot Growwell (zi cao), rhizome of Japanese Fleeceflower (hu zhang), common Picria herb (ku shen), and fruit of Japanese Apricot (wu mei).

TCM patent drugs or simple folk remedies

TCM has many patent drugs or simple folk remedies for relief of symptoms. Physicians usually prescribe these to complement other treatments.

Qi-gong

This method is beneficial for regulating the body and mind, strengthening the constitution, and relieving the adverse effects of radiotherapy or chemotherapy. Patients select relevant exercises in consultation with their physician. A desirable result can only be achieved by long-term and persistent practice.

For example:

First prepare by adopting a half standing and half sitting posture; hold the arms tight at the side with the each hand in a fist; the two feet are a shoulder’s width apart and the eyes are slightly closed.
Slowly start to inhale, grab the ground with the toes, contract the groin area, and lift up the anus.

Concentrate on making the breath (qi) si

Prevention

TCM methods of prevention and management are similar to Western medicine, please see Western section for reference; nursing management is a characteristic of TCM. TCM physicians concentrate on the following:

Psychological consultation and reassurance
Both the physician and family members should try to relieve the patient’s mental burden through language and behavior, so as to build up the patient’s self-confidence to fight the cancer. Patients can also help by practicing qigong. Keeping good personal hygiene, eating a moderate diet, avoiding cigarettes and alcohol, and keeping stress to a minimum, are also important ways to prevent disease progression.

Food and dietary therapy
Patients should have multiple small meals everyday; the food should be light and easily digested, and cover all essential nutrients. The daily diet should include an increased intake of fiber and fruit.Â TCM functional foodÂ has a long history, and the use ofÂ tonicsÂ taken with food pre-date their use as medicine. Combined with food, tonics are absorbed better and are seen as an ideal way to keep bodily functions in check.

Porridge of Water Caltrop Therapeutic benefits: used as a tonic to invigorate the stomach and nourish the intestines.
Â
Ingredients:
10-20 pieces	water caltrop	Â
1 tablespoon	honey
about 1 cup	glutinous rice
Â
(Job’s tears, lotus seed or the seed of Golden Euryale (qian shi) can replace water caltrop with the same results.) Method: Peel off the skin of the water caltrop and cook in a pot with sufficient water; when it turns into a semi-paste, add the glutinous rice and further cook into porridge. Add one tablespoon of honey before serving.

Other functional foods like dried mushrooms, white and black fungus, and fresh mushrooms are also recommended. These foods enhance the immune system and improve the body’s constitution.

Four examination methods: Questioning/history taking, inspection, auscultation (listening) & olfaction (smelling), and palpation.

acuherb — Thu, 01 Sep 2011 19:20:32 +0000

The four methods have their unique clinical functions and cannot be replaced by one another. Sometimes, false manifestations of a disease occur which emphasize the importance of integrating all diagnostic methods.

The above methods are esential to determine the cause and origin of the problem from which an individual suffers. As has been discussed in this article, the symptoms experienced or felt on the outside of the body can often reflect a problem with the internal organs, yin yang balance or qi (vital energy) flow. Causes of the symptoms are often attributed to exogoneous evils that invade the body and disrupt its internal balance leading to illness, but illness can also arise on the inside of the body and express symptoms on the outside. A skilled TCM practitioner is usually able to distinguish where the origin of the problem comes from by using the examination techniques explained in this article.

1. Listening

Listening to the Voice

Speaking Voice: Generally, speaking in a loud and sonorous voice indicates syndromes of heat or shi type, while a feeble, low voice indicates syndromes of the cold or xu type.

Disordered Speaking: Speaking incoherently and loudly or deliriously indicates shi syndrome. Speaking verbosely, feebly, and intermittently indicates syndromes of the xu type. Muttering to oneself denotes qi deficiency of the heart. Stuttering speech suggests upward disturbance of wind-phlegm.

Listening to the Respiration

Feeble Breathing: Feeble breathing accompanied by shortness of breath usually indicates xu syndromes.

Coarse Breathing: Forceful breathing with a coarse voice belongs to the shi heat type syndromes. Asthma with feeble, short breathing is a category of xu type asthma.

Listening to the Cough

Course coughing usually indicates shi type syndromes. A low cough with weak breathing indicates xu syndromes.

2. Smelling

Foul breath is due to pathogenic heat in the stomach, indigestion, caries, and an unclean mouth. Sour breath indicates food accumulation in the stomach. The offensive smell of a secretion or excretion including stool, urine, sputum, pus, leukorrhea, etc., usually indicates heat syndromes of the shi type. A stinking smell usually indicates cold syndromes of the xu type.

3. Questioning

Questioning involves asking the patient or the patient’s companion about the disease condition to assist diagnosis. Because the chief complaint of the patient is of primary importance, the main information dealing with the problem must be carefully solicited. It is necessary to grasp the important clinical data as well as to get a general understanding of the patient’s disease condition. The main categories of concern are:

Chills and Fever Aversion to Cold and Fever:

At the beginning of a disease, aversion to cold and Fever occurs simultaneously. This indicates exterior syndromes due to invasion by exogenous pathogenic factors. The exterior syndromes due to invasion by exogenous pathogenic cold and wind are characterized by severe aversion to cold, mild fever accompanied by an absence of thirst, no sweat, headache, general pain, superficial and tense pulse, etc. The exterior syndromes due to invasion by exogenous pathogenic wind-heat are characterized by severe fever, mild aversion to cold accompanied by thirst, sweating, sore throat, superficial and rapid pulse, etc.

Alternating Chills and Fever:

This particular symptoms occurs when exogenous pathogenic factors are in between the exterior and interior of the body, accompanied by a bitter taste in the mouth, dry throat, fullness of the chest, hypochondrium, etc. If a high fever follows the first occurrence of chills and is complicated with a severe headache which subsides after the fever is gone, this indicates malaria.

Fever Occurring Without Chills High fever:

This is usually due to the transmission of exogenous pathogenic cold from the exterior to the interior, which then changes into heat; or the transmission of exogenous pathogenic heat from exterior to interior resulting in shi type interior-heat syndrome accompanied by profuse sweating, thirst, forceful pulse, etc.
Tidal fever:

This is one of the main characteristics of yin deficiency or shi heat syndrome of the Yangming channel. Tidal fever due to yin deficiency often occurs at noon or night, accompanied by a dry red tongue. Tidal fever usually appears at dusk associated with constipation, abdominal distension, penis pain, etc.

Perspiration:

Sweat is transformed from evaporated body fluid by the function of yang qi. So perspiration has a certain clinical significance in reflecting the status of yang qi and body fluid. On should first ask whether the patient has sweat or not. If the patient is sweating, further questioning should be concerned with the characteristics and accompanied symptoms of perspiration.

Sweating of No Sweating:

Exterior syndromes without sweating are caused by exogenous pathogenic factors. Exterior syndromes with sweating are mostly exterior heat syndromes due to the invasion by exogenous pathogenic wind heat; or they may be exterior xu syndromes due to exogenous pathogenic wind.

Night Sweating:

Is usually the manifestation of yin deficiency, accompanied by tidal fever, flushed malar, red tongue proper with scanty coating, thready and rapid pulse.

Spontaneous Sweating:

This is a sign of qi or yang deficiency associated with fear of cold, lassitude, etc.

Profuse Sweating:

Excessive sweating together with high fever, thirst with desire for cold drinks, forceful pulse, etc. belong to interior shi heat syndrome. This is the outcome of excessive yang and heat compelling the outward flow of sweat. Dripping with sweat accompanied by lassitude, feckless breathing, cold extremities, and feeble pulse indicates the total prolapse of yang qi, also known as “sweating from exhaustion.”

Sweating of the Head:

Caused by heat in the upper jiao or damp heat in the middle jiao. It is caused by the heat in the upper jiao, it will be accompanied by irritability, thirst, yellow tongue coating, superficial and rapid pulse. if it is the result of damp heat accumulation, it will be associated with heaviness and tiredness of the body, dysuria, yellowish and sticky tongue coating, etc.

Food and Drink Appetite, and Taste No Appetite:

This is a symptom caused by the dysfunction of transformation and transportation of the spleen. Symptoms are emaciation due to chronic disease, poor appetite, loose stool, lassitude, and pale tongue proper with a thin white coating. If anorexia is associated with fullness of the chest, abdominal distension, thick and sticky tongue coating, then it is caused by the obstruction of pathogenic damp in the spleen.

Food Repulsion:

This is usually due to the accumulation of food in the stomach and intestines. It is often accompanied by distension and fullness of the epigastrium and abdomen, acid regurgitation, and a thick and sticky tongue coating.

Quick Hunger:

This is due to strong stomach fire and causes fast digestion.

Hunger and Anorexia Combined: This is due to injury of stomach yin and disturbance of xu heat.

Craving for Dirt Due to Intestinal Parasites:

This is common in children, and is a sign of parasitosis accompanied by emaciation, abdominal distension and pain, etc.

Thirst:

Whether the patient is thirsty or not often reflects the condition of body fluids. During the process of disease development, if there is no thirst, then the body fluid has not yet been damaged and it indicates a cold syndrome. If the patient is thirsty, it indicates a consumption or stagnation of the body fluid failing to nourish the upper body.

Generally, thirst with a desire for excessive drinking is commonly seen in heat syndromes. Severe thirst with a preference for hot drinks indicates a phlegm-humor obstruction which prevents the upward flow of body fluids. The upward flow of water usually causes vomiting after drinking due to thirst. If the patient is thirsty, but doesn’t want to drink, this indicates acute febrile diseases where the pathogenic factors have invaded the nutrient (ying) and blood (xue) systems of the body. If excessive drinking does not relieve the symptoms of thirst and then excessive urination follows, this suggests diabetes.

Taste:

Clinically, a bitter taste in the mouth is caused by pathogenic heat, especially the overflowing of heat from the liver and gall bladder. A sweet taste in the mouth is usually due to damp heat in the spleen and stomach. A sour taste is due to the accumulation of heat in the liver and stomach. A sour taste similar to spoiled food indicates injury by the accumulation of food. Tastelessness in the mouth is usually due to the dysfunction of transportation and transformation.

Defecation and Urination Shape of the Stool:

Dry stools shaped like sheep-dung are due to stagnation of heat or exhaustion of body fluid. A mucous stool is a sign of excessive damp caused by spleen deficiency. Loose bowels following dry stool are due to a dysfunction of the spleen and stomach, and an imbalance between dryness and dampness. Stools which are sometimes dry and sometimes loose are usually due to liver qi stagnation and spleen deficiency. Liquid stools with undigested food are due to the yang deficiency of the spleen and kidney. Diarrhea with yellow watery stool and burning of the anus is caused by damp heat in the stomach and intestines. Formed stools with undigested food and foul smell are the result of food accumulation.

The Color of the Stool:

Tarry stools are the symptoms of hemorrhaging in the spleen and stomach. Bloody and pussy stools are a sign of dysentery.

The Smell of the Stool:

Sour stinking stools are due to the accumulation of heat. A rotten egg stink is due to food accumulation.

The Sensation of Defecation:

A burning sensation in the anus during defecation is due to pathogenic heat in the rectum. Mild prolapse of the anus during bowel movements is the outcome of chronic diarrhea due to the sinking of qi and spleen deficiency. Tenesmus is a sign of dysentery due to qi stagnation in the intestines. Fragmentary defection is a manifestation of the liver failing to cause a free condition for qi. Diarrhea occurring soon after abdominal pain, and pain relieved after bowel movements, are signs of food accumulation. Pain not relieved after bowel movements is a sign of spleen deficiency and liver preponderance resulting in “liver-wood subjugating the spleen-earth.”

The Color of Urine:

Deep yellow urine indicates heat, while clear and profuse urine indicates cold. Turbid urine or a mixture of urine with sperm denotes the downward flowing of damp heat. Brownish urine indicates that pathogenic heat has injured the blood vessels.

The Amount of Urine:

An increased amount of urine indicates kidney qi deficiency. A decreased volume of urine is caused by the consumption of body fluid or by dysfunction of qi activities causing failure to transform body fluids into urine. Dribbling of urine or retention of urine indicates the exhaustion of kidney qi or the downward flowing of damp heat.

The Sensation of Urination:

A stabbing pain during urination, accompanied by an urgent and burning feeling, is caused by damp heat. Pain after urination mostly indicates the declining of kidney qi. Dribbling urination is due to the non-consolidation of kidney qi. Nocturnal enuresis is caused by the deficiency of kidney qi. Unconsciousness accompanied by incontinence of urine indicates that the heart has failed to control the mind and the urinary bladder has lost its restrictive capacity.

Pain

Headache:

Occipital headache, referring to the nape and the upper back, is a disease of the Taiyang channel. Frontal headache, referring to the supraorbital ridge, indicates a disease of the Yangming channel. Headaches of the temporal region are diseases of the Shaoyang channel. Vertex headache is a pain of the Jueyin channel. headache related to the teeth is a pain of the Shaoyin channel due to invasion by cold.

Pain of the Chest:

This is mostly due to the obstruction of phlegm or blood stasis, leading to qi stagnation.

Pain in the Hypochondriac Region:

Is caused by obstruction in the liver and gall bladder channel, or by malnutrition of these channels.

Epigastric Pain:

Is caused by disorders of the stomach.

Abdominal Pain:

Lower lateral abdominal pain is caused by qi stagnation of the liver, obstruction of the liver channel, or appendicitis or hernia. Pain around the umbilicus is seen in parasitosis, food accumulation, constipation, etc. Lower abdominal pain and distension is caused by dysuria and/or retention of urine. If there are no complicated urination symptoms, the usual cause is retention of blood in the lower jiao.

Low Back Pain:

Is mostly due to a deficiency of the kidney, invasion by cold damp, or blood stagnation in the channels.

Pain of the Limbs:

Pain may appear in joints, muscles, or channels and collaterals due to the invasion of exogenous pathogenic factors.

The Nature of Pain:

A wandering pain associated with numbness or itching is due to invasion by pathogenic wind. Pain associated with heaviness and soreness is most often caused by pathogenic damp. Severe pain with a cold feeling or fear of cold is caused by pathogenic cold. Pain accompanied by redness, swelling, and heat or fear of heat is due to pathogenic fire (heat). Distending pain or referred pain is caused by qi stagnation. Pain which is aggravated by pressure relates to the shi type of symptoms complex. Pain which is alleviated by pressure is related to the xu type of symptom complex.

Sleep

Insomnia associated with palpitation, dreams and nervousness is usually caused by the insufficiency of blood nourishing the heart. Insomnia accompanied by restlessness in the mind and difficulty in falling asleep indicates yin deficiency leading to preponderance of fire. Insomnia complicated by bitter taste, vomiting saliva, palpitation, irritability, and an inability to fall asleep indicates the internal disturbance of phlegm-fire. Insomnia due to the disharmony of the stomach indicates a derangement of stomach qi leading to restlessness in the mind during sleep.

Hypersomnia is commonly seen in febrile diseases caused by exogenous pathogenic factors; in qi deficiency caused by chronic diseases; in failure of the spleen yang to ascend due to the obstruction of damp; or in the condition of yang deficiency leading to excessive yin.

Menses and Leukorrhea

Antedated Menstruation:

Red color and an excessive amount indicates heat syndrome. Light color, post-menstrual pain in the lower abdomen is most often due to a deficiency of both qi and blood.

Postdated Menstruation:

Dark purple menstrual flow with clots, and premenstrual abdominal pain, most often indicates cold syndromes or blood stasis. Postdate menstruation with a scanty light-coloured flow indicates blood deficiency.

Indefinite Menstruation:

If it is associated with dysmenorrhea or distension of the breasts before menstruation, it is caused by the stagnation of liver qi.

Amenorrhea:

Many factors may cause amenorrhea, such as pregnancy, blood stasis, blood exhaustion, consumptive diseases, qi stagnation in the liver, etc.

Incessant Menstrual Flow:

If it is dark purple color with clots and abdominal pain, this indicates deficiency of the chong and ren channels, or failure of blood control by the spleen due to the sinking qi of the middle jiao.

Leukorrhea: Thin and whitish leukorrhea with little odor indicates deficiency of the spleen and kidney. Excessive yellowish and thick leukorrhea with offensive smell indicates the downward flow of damp heat.

4. Palpation

Palpation is a method of diagnosis using the hand to touch, feel, and press certain areas of the body to ascertain the patient’s disease condition. Generally there are two types: pulse feeling and body palpation.

Pulse Feeling

In traditional Chinese medicine the pulse is considered as having three divisions: cun, guan, and chi. A normal pulse is neither superficial nor deep, neither quick no slow, and it beats in medium frequency, i.e., 4-5 beats per breath, with a regular rhythm.

To feel the pulse correctly, place the patients hand comfortably on a cushion with the palm facing upward. First, the practitioner should put their middle finger on the guan division, then the index and ring fingers should naturally fall on the cun and chi divisions. Finger force should at first be light, then moderate and finally heavy to get a general picture of the depth, rhythm, strength, and form of the pulse. An even force should be applied on the three regions. Through comparisons of the three regions, the practitioner can gain a correct impression of the pulse as a whole. A normal pulse is of moderate frequency, i.e., 4-5 beats per breath, regular rhythm, even and forceful.

The following are abnormal pulses commonly seen in the clinic:

Floating Pulse (fumai): When the pulse is pressed lightly it appears under the finger, and when pressed heavily it becomes weak. It often occurs in the early stages of diseases caused by exogenous pathogenic wind cold and heat, i.e., exterior syndromes. If it is seen in patients who are suffering from prolonged chronic diseases, it indicates a dangerous site where the yang qi of the body flows outward.

Deep Pulse (chimai): No clear pulse is felt by superficial pressure, only by heavy pressure. This indicates an interior syndrome.

Rapid Pulse (sumai): The pulse beats rapidly at a rate higher than the normal 5 beats per breath (i.e., more than 90 times per minute). This indicates a heat syndrome.

Xu Type Pulse (xumai): If the pulses of the three regions are weak and forceless, this indicates xu type syndromes. These are mostly caused by both qi and blood deficiencies and are seen during the process of chronic diseases.

Shi Type Pulse (shimai): If the pulses of the three regions are forceful with both light and heavy pressure, shi type syndromes are present.

Slippery pulse (huamai): If the pulse is smooth and flowing, like a pearl rolling on a plate, this indicates excessive phlegm, retention of food, or shi heat type syndromes.

Rough Pulse (semai): This pulse is uneven and has a roughness similar to scraping bamboo with a knife. It indicates a deficiency of blood and essence, qi stagnation, and blood stasis.

Fine Pulse (ximai): This pulse is as fine as a silk thread, and indicates exhaustion of qi and blood.

Full Pulse (hongmai): This pulse beats like a dashing wave, with one rising wave following another. It indicates excessive heat.

Wiry Pulse (xuanmai): This pulse is straight and long, like a tremulous music string, seen usually in diseases of liver, gall bladder, pain, or phlegm-humor.

Tense Pulse (jinmai): The pulse is taut and forceful, like a tightly stretched cord, and occurs in diseases caused by cold, pain, or retention of food.

Hollow Pulse (koumai): This pulse is floating, large, and empty inside, feeling like a scallion stalk. It indicates a massive loss of blood and essence.

Hesitant Pulse (cumai): This pulse is rapid with irregular intermittent beats. It indicates excessive yang and shi heat, qi stagnation, pathogenic phlegm mixture with cold, blood stasis, etc.

Knotted Pulse (jiemai): This pulse is slow and uneven with irregular intervals. It indicates excessive yin, qi stagnation, pathogenic phlegm mixture with cold, blood stasis, etc.

Intermittent Pulse (daimai): This pulse is slow with regular intervals. it indicates qi exhaustion of the zang organs, or syndromes of wind and pain caused by emotional pathogenic fright and fear.

Body Palpation

This is a diagnostic method to ascertain abnormal changes in the body and to determine the location and nature of the disease through palpation and finger pressure.

Palpating the Skin and Muscle: Generally, if there is excessive pathogenic heat in the body, the patient will usually have heat on the body surface. Yang qi deficiency has a cold body surface on palpation. If the surface feels hot on first palpation becoming slightly hotter when you palpate longer, this indicates that the pathogenic heat has proceeded from the exterior to the interior of the body. Body palpation showing moist and smooth skin demonstrates that the body fluid is not yet damaged. If the skin and nails are very dry, this indicates consumption of the body fluids. If body palpation shows swelling and further pressure makes a depression, this indicates edema. If a depression appears on pressure and disappears after taking the hand away, this indicates qi distension. Palpating the skin can also indicate the patient’s sweat condition.

Palpating Hands and Feet: Coldness of the four extremities is mostly due to yang deficiency and excessive pathogenic cold. An overheating of the four extremities indicates excessive heat. Coldness of the four extremities with heat in the chest and abdomen is due to the retention of internal heat preventing the flow of yang qi outward. Heat in the dorsum of the hand is a sign of disease caused by exogenous pathogenic factors.

Palpating the Epigastrium and Abdomen: If the patient has fullness and distention of the hypochondrium, palpation may demonstrate hardness and pain in this region. This is known as an accumulation of excessive pathogenic factors in the chest of the xu type. If the hardness extends over a large area in the chest, it is due to phlegm-humor. Palpation of the abdomen showing abdominal distention with a tympanitic note on percussion, but with normal urination, indicates qi tympanites. Abdominal distension with a splashing sound like water, and accompanying dysuria indicates was tympanites or ascites. If hand pressure relieves the abdominal pain, it is considered to be a xu type; if the pain is made worse by pressure, it is a shi type. Immovable hard masses in the abdomen with pain fixed in a certain area are due to blood stasis. However, if the patient feels that lumps sometimes appear and disappear with unfixed pain, and palpation of the abdomen shows they do not exist, then this is due to qi stagnation.

Palpating Channels and Points: Clinical practice proves that in some diseases there may occur tenderness or abnormal reactions along the courses of the affected channels or at certain points. These signs have significance in diagnosis by palpation, especially in acupuncture treatment. For example, there may be tenderness at Pt. Zhongfu (Lu. 1) or Pt. Shufu (K. 27), which are closely related to the disorders of the lung and trachea. In diseases of the heart and stomach, tenderness may occur at Pt. Jugue (Ren 14), Pt. Zhongwan (Ren 12), Pt. Burong (St. 19), or Pt. Liangmen (St.21). In disorders of the liver and gall bladder, tenderness may be at Pt. Qimen (Liv. 14) and Pt. Riye (G.B. 24). In diseases of the spleen, tenderness may occur at Pt. Zhangmen (Liv. 13) and Pt. Huangmen (U.B. 51). In disorders of the kidney, Pt. Jingmen (G.B. 25) and Pt. Zhishi (U.B. 52) may have tenderness. Tenderness at Pt. Tianshu (St.25). Pt. Daji (St.27) and Pt. Fujie (Sp. 14) may be closely related to disorders of the intestines. Tenderness at Pt. Guanyan (Ren 4), Pt. Qihai (Ren 6) and Pt. Zhongji (Ren 3) may have a close relation with disorders of the urinogenital system. When there are abnormal reactions appearing at the above points, they may reflect pathological changes of the related zang or fu organs.

Introduce traditional Chinese medicine

acuherb — Wed, 03 Aug 2011 21:11:50 +0000

What is Traditional Chinese Medicine?

Traditional Chinese medicine refers to health practices, approaches, knowledge and beliefs incorporating plant,
animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in
combination to treat, diagnose and prevent illnesses or maintain well-being.

Traditional Chinese Medicine (TCM) is an ancient medical system, which has existed about 3000 years in China.
The theory of TCM is based on Chinese ancient knowledge of anatomy, acupuncture, physiology, herbal
knowledge and clinic experience. In this system, doctors will diagnose patient with special techniques involved with
detecting the patients’ symptoms, pulse, throat, tongue, color of the face, the sound of patient etc. After the doctor
gives a diagnosis, the patient will receive treatment including herbal medicine, acupuncture or acupressure to cure
the disease.

What is Chinese herbal Medicine?

Chinese herbal medicine has a long history of at least 3000 years of written accounts. It developed from folk
medicine into a complex medical system that shares its theoretical background, its diagnosis and treatment plans
with acupuncture and other branches of Chinese medicine.

Of all professional medical systems still practiced today in the world Chinese medicine has the longest continuous
history. It is also important to note that Chinese herbal medicine has developed a complete system of classification
of medicinal substances describing their therapeutic qualities that is unequaled by any other herbal practice of
other cultures.

What is special about Chinese herbs for you is that ? because Chinese medicine treats the whole person and not
the disease ? each prescription will be matched exactly to your condition and needs!

The term “herbal” medicine is actually not quite correct. Although about 80 % of the medicinal substances used
are of plant origin, another 16 % are animal substances and 4 % are derived from minerals. The newest Chinese
“Materia Medica” (the complete listing of medicinal substances), compiled in 1977, lists a total of 5,767 substances.
Of these, about 300 are widely used with 150 of them considered indispensable for a well-stocked pharmacy. Not
all of these substances are native to China, about 20 % were introduced through trade from other Asian countries,
India (e.g. frankincense and myrrh) or the Americas (e.g. American ginseng).

In China, people have used natural herbs to treat a wide variety of diseases and conditions. These herbs are
called herbal medicine, which are composed of roots, bark, flowers, seeds, fruits, leaves, and branches. It is well
known that Traditional Chinese Medicine has over 3000 years history and Chinese herb medicine is one of most
important parts of Traditional Chinese Medicine which also includes acupuncture. In China, there are over 3000
different herbs that can be used for medical purposes. However, about 300 to 500 of these herbs are commonly
used. It is important to use herbs grown in China rather than outside of their native environment. One must use the
right herb from the right source to get the full benefit.

Chinese herbology is a system of herbal treatment. It is not applied in the way that most herbs and medicines are
used in our Western world. For example, all medicines (including herbal medicines) under western schools of
thought are used because they are known to produce certain effects. St. John’s Wort and Prozac are used for
depression because they are both known to counter depression in the human body. Chinese Herbal Medicine was
developed as an integral part of Chinese Medicine. It is used to re-harmonize imbalances in the body. Therefore, a
cough would not be treated by choosing an anti-tussive alone. It must first be determined where the cough is
coming from, and then the appropriate group of herbs would be combined to treat the problem.

Increasing Use and Popularity

TCM has maintained its popularity in all regions of the developing world and its use is rapidly spreading in
industrialized countries.
? ????????In China, traditional herbal preparations account for 30%-50% of the total medicinal consumption.
? ????????In Ghana, Mali, Nigeria and Zambia, the first line of treatment for 60% of children with high fever resulting
from malaria is the use of herbal medicines at home.
? ????????World Health Organization (WHO) estimates that in several African countries traditional birth attendants
assist in the majority of births.
? ????????In Europe, North America and other industrialized regions, over 50% of the population have used
complementary or alternative medicine at least once.
? ????????In San Francisco, London and South Africa, 75% of people living with HIV/AIDS use TM/CAM.
? ????????70% of the population in Canada has used complementary medicine at least once.
? ????????In Germany, 90% of the population have used a natural remedy at some point in their lives. Between 1995
and 2000, the number of doctors who had undergone special training in natural remedy medicine had almost
doubled to 10 800.
? ????????In the United States, 158 million of the adult population use complementary medicines and according to the
USA Commission for Alternative and Complementary medicines, US $17 billion was spent on traditional remedies in
2000.
? ????????In the United Kingdom, annual expenditure on alternative medicine is US$ 230 million.
? ????????The global market for herbal medicines currently stands at over US $ 60 billion annually and is growing
steadily.

Will Chinese “herbal” formulas help me?

The answer is very positive “Yes”. Most physicians trained in Oriental medicine will prescribe dietary supplements
derived from plants and minerals, though animal products are sometimes used. Sometimes these may be part of
the initial treatment, or they may be used after a series of acupuncture sessions has clarified the diagnosis.
Patients should expect that any behavioral or dietary changes will need to be continued to maintain the benefit of
the Oriental approach, and often dietary supplements are taken daily for weeks or months. Free of most of the
side effects of pharmaceutical drugs, Chinese formulations are often available in modern extract or tablet form that
is more convenient than the traditional “soups” used in the Orient.

Chinese Herbal therapy or herb medicine has three main functions:

1. Treat the acute diseases and conditions such as killing bacteria or a virus;
2. Heal chronic illness such as gastrointestinal disorder, respiratory disorder, allergies, immune system deficiency,
etc. by strengthening the body, helping it to recover;
3. Maintain a healthy life daily by keeping the balance of human body.

Chronic illness treatment – As we know, many people with chronic illness may take a number of different
conventional drugs daily. ?Chinese herb medicine is a very good alternative for those who are looking for a natural
alternative for the conventional western medicine. There are many very efficient Chinese herbal patent medicines
and prescribed herb formulas for the medications taken for pain syndromes, gastrointestinal disorders,
neurological disorders, stress related syndromes, respiratory disorders, heart problems, sexual dysfunction,
allergies and immune system ?deficiencies, as well as replacements for antibiotics and anti-inflammatory drugs.

Side effect reduction – As mentioned earlier, Chinese herbs are safer and have less side effects. Actually they can
be taken to reduce the side effects of other medication such as antibiotics, chemotherapy, etc. It is well known that
antibiotics weaken the immune system. Herbal therapy can strengthen the system. ?Also, during chemotherapy, the
white blood cell count drops, which causes fatigue, lack of energy and appetite. Herbal therapy has proven quite
successful in relieving the side effects of chemotherapy.

For prevention – People may take Chinese herb medicine for disease prevention. For instance, for a person
suffering from frequent headaches, taking herbs to prevent the headache from ever starting is a much better
option than taking a pain reliever after the fact. Herbs are also used to prevent the flu, menstrual cramps and
premenstrual syndrome, among other things. Herbal therapy can also be used for general health maintenance.
Tonic herbs are also used to increase energy and to slow the aging process. They are also used for enhancing
sexual energy and for cosmetic purposes. Herbs arc also used to treat minor symptoms that are not severe
enough for heavy chemical drugs, symptoms that cannot be diagnosed by Western medicine, and symptoms and
illness that are not easy to treat, such as mononucleosis and ?immune system deficiencies.

We have a complete pharmacy of herbs to dispense for our patients. Bags of loose herbs have to be simmered for
at least an hour and a half, and some ingredients have to be added at different times to be most effective, as too
much heat will disturb the delicate ingredients. For your convenience, we have Chinese patent medicines and in
granular form as well.

What about contamination of herbs and patent medicines?

You are correct to be concerned about this. Regulations for pesticides and herbicides are different in the source
countries for bulk herbs than they are here. Those that are not heavily treated with chemicals may be
contaminated with insect and other pests or molds. Correct storage is also important.

Some products from China and other countries have been found to be contaminated with arsenic, mercury, lead,
and cadmium. Adulteration with pharmaceutical drugs has also occurred. Toxic plants have sometimes been
mistakenly substituted for the correct ones. Once again, your best assurance will come from working with a
knowledgeable practitioner of all aspects of Oriental medicine. Now a lot of Chinese herb distributors in US have to
follow the FDA?s rules for importing and selling herbs.

In what form do Chinese Herbs come?

Chinese herbs may be taken in any of the following forms:

Raw Formulas

A raw formula consists of carefully individually weighed unprocessed herbs placed together in individual bags. One
bag is boiled for either one or two day dose. These formulas are best boiled in a clay herb pot which assists in
even cooking and the preservation of the medicinal properties of each herb formula. There are different cooking
instructions for different formulas, so you should consult your doctor on your specific cooking instructions.

Patent Medicine

This term is used for famous formulas used for generations for common illnesses. Patent medicine includes tiny
herbal pellets that are taken two to three times daily. A standard dose may be as high as 8-10 pills three times per
day. The reason for this is because these pills are so tiny. Taking herbs in this form is sometimes more practical
for the patient who does not have as much time to prepare. However, they are pre formulated based on a general
problem. If your problem does not fit the specific indication, your practitioner may choose to give you a raw or
granular formula.

Pills, Tablets or Capsules

These are raw formulas cooked and freeze dried. The benefit of using this method is the same as the raw formula
itself but without cooking time involved. However, as effective as these formulas are, raw formulas are still the best
method for taking Chinese herbs.

Syrup

A syrup is made from a high concentration of herbal tea mixed with honey or sugar syrup. The syrup form always
has a sweet taste and the medicinal effect is milder. Thus, it is easily taken and easily absorbed.

Liniment or Cream

There are numerous topical liniments or creams for many different medicinal uses. It is an oil-base medicine in
liquid form. These are highly effective when used under the appropriate circumstances.

Plasters

The Chinese herbal medicine is mixed into the adhesive formula to form the medicinal plasters. These plasters are
applied externally to reduce pain and decrease inflammation. Sometimes, the adhesive plaster may cause an
allergic reaction for a few patients.

Granules

This form is made with a fine herbal powder or herbal extract in dried granular form. This form maintains some of
the special attributes of herbal tea.

Are Chinese Herbs good for everyone?

There is never one answer for every problem. Oriental Medicine is based on the foundation of this philosophy. A
person’s underlying condition must be taken into account in the treatment of his or her problem. With all of the
attention that herbal medicine is receiving these days, the impression is given that if you hear that an herb is good
for a certain problem then it must be good for everyone for that problem! THIS IS NOT TRUE! A single herb is
almost never prescribed for any patient within the scope of Chinese Herbal Medicine. Formulas must always be
delicately composed to protect the patient’s constitution against the possible unwanted effects of the herbs he or
she needs to take. This is the way side effects are avoided and better results are achieved.

Can I take Chinese herbs with my regular medication?

Your health-care provider should be aware of all medications, vitamins, herbs, and recreational drugs you are
taking. Combining any of these substances may or may not be a good idea. It is important to rely on the advice of
your health-care provider.

Is taking daily vitamins that contain Chinese Herbs a good idea?

Vitamins often contain Chinese Herbs. As we stated above, one herb or one group of herbs is never good for all
people. Using vitamins that contain herbs is not a good idea in our opinion unless you have been advised by your
health-care provider to do so. A good example of this is a diet product that contains vitamins and mineral designed
to burn fat. These products very often contain a Chinese Herb, Ephedra (Ma Huang). This herb has been shown to
stimulate the metabolism. However, in Chinese Medicine it is used as an acute anti-asthmatic for immediate
treatment only. If this herb is used long-term it can have damaging effects on the body’s state of health and if
taken in a high enough dose, it could stimulate the body so much, it could possibly produce a heart attack. This is
a very clear example of a good thing that can potentially save a life being used for an incorrect set of
circumstances creating the potential for taking a life. This is why Chinese Herbal Medicine needs to stay in the
hands of the professionals who have been trained to use it. Another example is Ginseng. Everyone knows what
this is. The problem is everyone THINKS they know what it is good for! The media describes it as something that is
good for your immune system, something that is good for energy. While this is true, if we understand Oriental
Medicine, then again we know that what is good for one is not good for all. Ginseng in the wrong hands or taken
long term can actually produce extreme lethargy and fatigue! This is the important part of the message that is not
being communicated to the public.

Why are there so many herbs in Chinese formulas?

Chinese herbalists usually do not prescribe a single herb for their patients. Chinese herbs usually are used in
combinations of 2 to 15 herbs. There are three major reasons to support the combination practice. Mutual
Reinforcement involves combining two or more very similar herbs together to create a stronger effect. Mutual
Assistance is the way to use one herb to help another work better. Mutual Restraint means to use one herb to
reduce or eliminate side effects of another herb in the combination.

All of these demonstrate that an herbalist should be experienced and knowledgeable about herbs before
attempting to combine them. ?Otherwise, Mutual Inhibition occurs when one herb reduces another’s effectiveness;
incompatibility occurs when the combination of certain herbs produces side effects or becomes poisonous.

I receive many e-mails and phone calls regarding where to buy single Chinese herb. I think that many of people in
the United States misunderstood Chinese herb medicine when they tried to use a single Chinese herb to treat
some diseases and conditions. ?One of the most important aspects and the advantages of Chinese medicine is the
power of mixing.

An intricate system has been developed over thousands of years that utilizes herbs as the primary means of
maintaining health. One of the differences between western and Chinese herbology is the number of herbs used in
a formula. Typically modern Chinese formulas contain between 6-16 herbs. Medicinal herbs are combined to
increase positive effects, and to minimize negative effects. Herbs are designated as chiefs, deputies, assistants, or
envoys depending upon their role in the formula. The chief provides the main therapeutic action, and the deputies
enhance the action of the chiefs. The assistants treat accompanying symptoms, or moderate harshness. The
envoys have a harmonizing effect, or guide the formula to a certain area of body or acupuncture channel.

Herbs can be combined to reinforce each other’s action. Together they have a more powerful action than either
alone. Herbs are also combined because they support one another. Astragalus (Huang Qi) and Tang Kuei (Dang
Gui) are combined because Astragalus helps the body absorb Tang Kuei, which is considered a blood tonic.

Herbs are also combined to balance effects. A famous combination of herbs is Coptis (Huang Lian) and Evodia
(Wu Zhu Yu). Coptis is bitter and cold, and Evodia is warm. Together they reduce vomiting, acid regurgitation and
liver related pain. Digestants such as Oryza (Gu Ya) are usually added to formulas that are difficult to digest. To
reduce toxicity, licorice is often added to formulas with aconite by traditional Chinese doctors. Herbs are used to
guide a formula to a certain area of the body. Cimicifuga (Sheng Ma), a relative of Cohosh helps bring herbs to the
upper part of the body for treating mouth sores.

Herbs are also combined to treat the complex presentations seen in the clinic. For example, we often see
fibromyalgia patients with joint and muscle pain, insomnia, fatigue, and poor digestion. Herbs are administered to
treat pain, improve digestion, and ease stress. Herbs traditionally used for anti depressant effects are usually also
included. In the case of a client with Hepatitis C, we may select herbs with anti-viral effects, specific liver protective
properties, and to help alleviate liver related pain.

This approach integrates, refines and directs the properties of many herbs. This is in contrast to the Western
herbal approach that uses herbs according to their specific medicinal properties. Traditional Chinese herbal
formulas are extremely effective and very safe. Just as you need a carefully balanced diet with many different
foods to maintain the nutritional balance of your body, so in Chinese medicine we believe herbal formulas must be
carefully balanced to correctly balance your body systems.

How about the quality of Chinese herbs?

“Health Concerns” was the first American manufacturer of Chinese herbs used by practitioners. We have used
these Chinese herbs for centuries, giving special attention to American health concerns. A team of biochemists,
herbalists, clinicians, Oriental medical doctors and translators work together to make sure the quality of Chinese
herbs that are used by health professionals throughout the World.

The herbs we used in Health Concerns formulas are of the highest quality, not exposed to pesticides or fumigated;
many are wild-crafted. All are specially selected to meet our rigid microbiological standards and those for
freshness.

Finally, we have used all Chinese herbs from American herbal companies that are approved by FDA and they
import Chinese raw herbs from China. The quality and effectiveness are assured.

How long before I can expect to notice a difference?

Each person will respond a little differently, of course. Some of the formulas will work quicker than others. As a
rule, for most cases best results can be obtained when patients continuously take the correct formula in a few
weeks by following doctor?s directions. If you haven’t gotten the anticipated results, you should seek the help of an
experienced practitioner.

Are Standardized Herbs Better?

Standardized is a term which means that there is a guaranteed amount of a certain botanical constituent. For
example, some herbal compounds can be standardized to contain Hypercin, Flavones, Mahuang for ephedrine,
and Milk Thistle for its silymarin content. Standardized does not necessarily mean stronger or better. Chemical
solvents such as hexane benzene, acetone, and methyl chloride are typically used in standardized extracts.
Residues of the chemicals are found in the finished product. Furthermore they may be hazardous to the
environment.

Every patient is different medically even if he or she has the same diagnosis. Standardized herbs are only for
general medical issues not for specific problems, so the best way to solve this issue is to consult with your herbal
doctor for more assistance in order to get better formulas for your specific case.

How effective are Chinese herbs?

Very effective. You will experience very impressive results in most cases.

Where do Chinese herbs come from and how are they grown?

Chinese herbs coming to the US are grown primarily in China or Taiwan or other Asian countries. The Chinese
have developed refined methods of cultivation for large yields of high quality herbs. Contrary to common concerns,
Chinese herbs are usually grown organically (pesticides only work for more cultivated plant species and are not
affordable for Chinese farmers) and are generally not irradiated.

Some raw materials are grown outside of China, imported for processing and may be exported again.

What about animal substances? I’m a vegetarian!

We do use animal substances for our patients based on medical issues but not for every single patient. There has
been some controversy regarding the killing of endangered animal species and their trade on the black market (e.
g. tiger bone, rhino horn), but such substances are excluded from import to the US and American practitioners
would consider their use unethical. With the vast number of substances available, substitutions can easily be made
(e.g. buffalo horn for rhino horn).

The same applies for substituting plant materials for animal materials for clients who object to the ingestion of
animal parts. A responsible practitioner will disclose ingredients and get the client’s approval before mixing a
prescription.

How are Chinese herbs being taken?

The classic way of ingesting Chinese herbs is to make a decoction from raw dried materials. This means that the
herbs are cooked at a low boil for a long time and then drunk as a tea. This is a very potent, although tedious and
time-consuming method. And Americans often object to the strong taste.

A popular form that maintains the versatility and potency of decoctions, but is convenient to take and usually better
tasting is extract granules. They are dried (dehydrated) decoctions that come as a gritty powder that is mixed with
warm water to make an instant drink. They come both as premixed formulas and single herbs.

In addition, commonly used formulas from both classical and modern prescriptions are available as tablets, pills,
powders, liquid extracts, syrups, medicinal wines, herbal plasters and liniments.

As you know, prescribed herbal medicine is traditionally taken in tea form. The Human body absorbs tea easily and
quickly so it is the most commonly used method. Sometimes, if the smell or taste of the herbal medicine is
unpleasant, capsule or tablet form of this herbal medicine is recommended. Tea should always be warm, and
capsules or tablets should be swallowed with warm water. Generally, it is best to take herbs just before you serve
meals. You should consult a herbalist for specific instructions on taking herbs. For example, tonic herbs, to
promote health, are best taken before meals. Purgative herbs, to cleanse the system, are best taken on an empty
stomach. Herbs that either irritate the stomach or are taken to protect the stomach should be taken after eating.
Herbs for insomnia and other sleeping disorders should be taken at bedtime.

Can I just pick up something in Chinatown or at the health food store?

Chinese “patent medicines”, found in Chinatown or Asian grocery stores, are readily available over-the-counter
and very inexpensive. A number of problems have been associated with them such as incorrect labeling,
undisclosed addition of pharmaceuticals, illegal import and contamination with heavy metals. Recently the FDA has
tightened controls. The professional community monitors their manufacturing and trade. Many practitioners,
including me, use them selectively.

Chinese herbs found in health food stores frequently come as single herbs or as tinctures, both of which are “non-
traditional”. They can be very helpful, however, they may be contraindicated for your condition and have potential
side effects with long-term use. In case of a complex condition check with a trained practitioner.

?.Although Chinese patent ?herbs are relatively safe and have less side effects, I do not recommend you buy
Chinese ?patent herbs from herb store or other channels without obtaining advice from a certified ?herbalist.

Why do many Chinese herbs taste so bitter?

The active ingredients of Chinese herbs are frequently roots and barks compared to the leaves and flowers that
are dominant in Western herbal teas. They need to be cooked for a long time to extract the active ingredients.
However, because the strongest medicinal ingredients are found in roots and barks, Chinese herbs tend to be
much more potent.

How does the practitioner pick the right herbs for me?

Chinese medicine diagnosis is made based on “discrimination of patterns of disharmony”. The practitioner will take
a thorough health history, ask questions regarding all body functions, feel the wrist pulse, look at the tongue and
palpate certain body areas. The various findings are combined into a composite diagnosis regarding which body
systems are in disharmony, based on Chinese medical theory. All medicinal substances as well as foods are
classified and described according to several categories, e.g. their flavor, their energetic temperature and their
therapeutic properties

What is the training for Chinese herbal medicine in the USA?

Chinese herbal medicine in the United States was long practiced in Asian immigrant communities, while
acupuncture colleges have added herbal programs only for the past decade or so. A majority of colleges now offer
herbal training with a minimum of 450 hours, which is prerequisite for taking the national certification exam in
herbology given by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). While
the NCCAOM acupuncture exam is standard requirement for licensing in most states, the herbal exam is only
mandatory in a few. It is not required in Washington State; therefore many practitioners may not have opted to take
this exam, although they have the required training. Those who have passed the exam have earned the title Dipl.
C.H. (NCCAOM), diplomate of Chinese Herbology of the NCCAOM, or Dipl. O.M. diplomate of Oriental Medicine of
the NCCAOM. The latter one includes acupuncture & Chinese herbs.

A number of acupuncture colleges offer an herbal track only as elective. Some older practitioners who studied
acupuncture before herbal programs were introduced have taken short postgraduate programs of 150 or less
hours. So make sure to inquire regarding herbal training when seeking out a practitioner.

“Prescribing” of Chinese herbs is not limited to licensed acupuncturists; other health professionals may
recommend Chinese herbal supplements, and health food stores offer them over-the-counter for self-prescribing.
Although this may be helpful for day-to-day problems, for more complicated or chronic conditions I strongly advise
that you consult with a trained and qualified practitioner.

Are Chinese herbs being researched?

Since the Chinese revolution and the founding of the People’s Republic of China the body of medicinal substances
has been subject to chemical analysis and ongoing research on medical efficacy. New therapeutic effects have
been discovered based on this research and many traditional herbs are now being used for contemporary
diseases like high blood pressure, diabetes, cancer, AIDS and many more.

Are Chinese herbs toxic and do they have side effects?

If a qualified practitioner prescribes Chinese herbs and the formula matches the pattern, they are virtually without
side effects. Most Chinese medicines have very low toxicity. Toxic parts of plants are removed or processed to
eliminate toxicity. Herbs with potential side effects are combined appropriately and given in small doses only
The most common side effect may be some bloating because of the cloying nature of tonic herbs. This can easily
be corrected by adding digestive herbs into the prescription.

Can I take Chinese herbs with my vitamins or homeopathic remedies?

Herbs may be combined with other supplements, although many herbs have some nutritional value and you may
find that you may not need as many vitamins. Some American supplements combine vitamins & minerals with
Chinese herbs for particular needs.

From a Chinese medical viewpoint, herbs can safely be taken along with homeopathic remedies, although a
classical homeopath will most likely state the opposite. The therapeutic strategy used is very different, so it may be
better to choose one approach and stick with it. Chinese herbs are more natural ? and in my opinion much more
nourishing ? than homeopathic remedies which work on a subtle energetic level.

Can children take Chinese herbs?

Yes, in reduced dosage.

What do Chinese herbs treat and when are they indicated?

Chinese herbs treat the full range of human illnesses. An acupuncturist will use herbs to enhance the acupuncture
treatments on an individual basis.

Have Chinese herbs been processed before use?

Yes. Chinese Herbs have been processed before use.

Why? First of all, the processing can reduce any possible side effects of herbs by detoxifying the herbs. The
second reason for processing herbs is for filtering out impurities such as dirt and sand. Another reason is the
processing can soften the strong taste or smell of herbs. Finally, it is very important to emphasize that processing
herbs can enhance their functions.

Can you tell me the difference between Chinese patent and prescribed herbs?

Chinese Patent herbs are premixed herb combinations according to the traditional formulas developed by experts
in traditional Chinese medicine through over 3000 years. They are similar to over-the-counter-drugs and usually in
the form of pill, capsule and liquid. The advantages of Chinese patent herbs are convenience, ease to take, less
expensive. However, the patient’s symptoms must fit the patent herb’s narrow indications.

According to an individual patient?s symptoms, a herbalist gives a diagnosis and prescribes herbal formula called
personalized medicine. Generally speaking, prescribed herbs are more effective than patent herbs because your
herbalist tailors the prescribed herbs exclusively to your symptoms and conditions if he or she is very good at
traditional Chinese medicine.

Do granular herbs do the same good as the raw herbs in prescribed herbs?

Yes! The granular herbs are made from the raw herbs. First of all, best herbal sources from China are selected.
Then these raw herbs are purified. After that they are processed through steaming, cooking, and finally
condensed into fine granular particles. Therefore, they are easily dissolved and absorbed and enhance the
healing process.

Could you give me some precautions while I take herbs?

You should take a certain amount of caution when you take Chinese herbs. ?For instance, some herbs are too
strong for pregnant women and may cause miscarriages. ?Certain foods can have adverse effects on the herbal
therapy. Generally speaking, when taking Chinese herbs, one should avoid food that is raw (fruit is okay, but
vegetable should be cooked), greasy, strong tasting or smelling, difficult to digest, or irritating to the digestive
system (like spicy foods). It is always a good idea to get advice from an herbalist before you take Chinese herbs.